Oncology & Hematology Coding Alert
We Bring You the 2008 PQRI in a Nutshell
Focus on the new measures that will affect you most You-ll find a handy new 2008 PQRI chart with every new issue of Oncology Coding Alert. For each PQRI measure, you-ll get the details on the appropriate ICD-9, E/M and PQRI codes that will help you code more accurately and ensure your reimbursement. For this issue, we concentrate on PQRI measures related to leukemia and MDS. Important: Pay close attention to these modifier descriptors to boost your PQRI coding accuracy: - 1P -- exclusion modifier due to medical reasons - 2P -- exclusion modifier due to patient reasons - 3P -- exclusion modifier due to system reasons - 8P -- reporting modifier -- action not performed, reason not otherwise specified. CMS notes that for the following measures: - the patient must be aged 18 years or older - the measure need only be reported once per patient per reporting period. For additional information on the requirements for these measures, please refer to the page indicated in CMS- "Coding for Quality: A Handbook for PQRI Participation." You can find this online at http://www.cms.hhs.gov/PQRI/Downloads/2008PQRICodingforQualityHandbook.pdf. 67 -- Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow ICD-9 diagnosis codes: 204.00-208.00 (Leukemia), 238.72-238.75 (Myelodysplastic syndrome) CPT E/M service codes: 99201-99205 (Office, new patient), 99212-99215 (Office, established patient), 99241-99245 (Outpatient consultation) PQRI codes: - 3155F (Cytogenetic testing performed on bone marrow at time of diagnosis or prior to initiating treatment); or - 3155F-1P or 3155F-2P or 3155F-3P; or - 3155F-8P Refer to page 150 of the CMS Handbook for documentation information on this measure. 68 -- Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy ICD-9 diagnosis codes: 238.72-238.75 (Myelodysplastic syndrome) CPT E/M service codes: 99201-99205, 99212-99215, 99241-99245 PQRI codes: - 3160F (Documentation of iron stores prior to initiating erythropoietin therapy) and 4090F (Patient receiving erythropoietin therapy); or - 3160F-3P and 4090F; or 4095F (Patient not receiving erythropoietin therapy); or - 3160F-8P and 4090F Refer to page 152 of the CMS Handbook for documentation information on this measure. 70 -- Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry ICD-9 diagnosis codes: 204.10 (Lymphoid leukemia; chronic; without mention of remission) CPT E/M service codes: 99201-99205, 99212-99215, 99241-99245 PQRI codes: - 3170F (Flow cytometry studies performed at time of diagnosis or prior to initiating treatment); or - 3170F-1P or 3170F-2P or 3170F-3P; or - 3170F-8P Refer to page 146 of the CMS Handbook for documentation information on this measure.
Oncology & Hematology Coding Alert
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